急性创伤性脊髓损伤患者的功能障碍评估:文献系统评价。
Assessment of impairment in patients with acute traumatic spinal cord injury: a systematic review of the literature.
机构信息
Department of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada.
出版信息
J Neurotrauma. 2011 Aug;28(8):1445-77. doi: 10.1089/neu.2009.1152. Epub 2010 Apr 6.
The most common primary end-point of the trial on treatment of traumatic spinal cord injury (SCI) is the degree of impairment. The American Spinal Injury Association (ASIA) Standards have been widely used to assess motor function and pin-prick and light-touch sensory function. In addition, pain assessment is another clinically relevant aspect of the impairment in individuals with SCI. Given this, we sought to systematically review the studies that focused on the psychometric properties of ASIA Standards and all previously used outcome measures of pain in the SCI population in the acute care setting. For the primary literature search strategy, the MEDLINE, CINAHL, EMBASE, and Cochrane databases were sought out. Subsequently, a secondary search strategy was carried out using the articles listed in the references of meta-analysis, systematic, and non-systematic review articles. Two reviewers (JCF and VN) independently selected the articles that fulfill the inclusion and exclusion, assessed the level of evidence of each article, and appraised the psychometric properties of each instrument. Divergences during those steps were solved by consensus between both reviewers. Of 400 abstracts captured in our primary search strategy on the ASIA Standards, 16 full articles fulfilled the inclusion and exclusion criteria. An additional 40 references were obtained from two prior systematic reviews on ASIA Standards. While 45 of 56 of the studies on ASIA Standards provided level 4 evidence, there were 11 level 2b evidence studies. Convergent construct validity (n = 34), reliability (n = 12), and responsiveness (n = 10) were the most commonly studied psychometric properties of the ASIA Standards, but two prior studies examined their content validity. Of the 267 abstracts yielded in our primary search on pain assessment, 24 articles with level 4 evidence fulfilled the inclusion and exclusion criteria. There was no study that examined pain assessment in the acute care setting. While 18 of 24 articles studied an instrument for assessment of pain intensity, the remaining six studies were focused on classifications of pain in the SCI population. In conclusion, the ASIA Standards represent an appropriate instrument to categorize and evaluate spinal cord injured adults over time with respect to their motor and sensory function. Nevertheless, further investigation of the psychometric properties of the ASIA Standards is recommended due to a lack of studies focused on some key elements of responsiveness, including minimal clinically important difference. The visual analog scale (VAS) is the most commonly studied instrument of assessment of pain intensity in the SCI population. However, further investigation is required with regard to its reliability and responsiveness in the SCI population. Our results also suggest that there is no instrument with appropriate psychometric properties for this particular population.
该试验治疗创伤性脊髓损伤(SCI)的主要终点是损伤程度。美国脊髓损伤协会(ASIA)标准已被广泛用于评估运动功能和针刺及轻触感觉功能。此外,疼痛评估是 SCI 患者损伤的另一个临床相关方面。鉴于此,我们旨在系统地回顾重点关注 ASIA 标准的心理测量特性以及 SCI 人群在急性护理环境中使用的所有先前疼痛结果测量的研究。对于主要文献搜索策略,我们在 MEDLINE、CINAHL、EMBASE 和 Cochrane 数据库中进行了搜索。随后,使用荟萃分析、系统和非系统综述文章中列出的文章进行了二次搜索策略。两名评审员(JCF 和 VN)独立选择了符合纳入和排除标准的文章,评估了每篇文章的证据水平,并评估了每个工具的心理测量特性。在这些步骤中出现的分歧通过两位评审员之间的共识解决。在我们对 ASIA 标准的初步搜索策略中捕获的 400 个摘要中,有 16 篇全文文章符合纳入和排除标准。从之前关于 ASIA 标准的两项系统综述中还获得了另外 40 篇参考文献。虽然 56 项 ASIA 标准研究中有 45 项提供了 4 级证据,但有 11 项 2b 级证据研究。最常用于 ASIA 标准的心理测量特性是会聚性结构有效性(n=34)、可靠性(n=12)和反应性(n=10),但有两项先前的研究检查了它们的内容有效性。在我们对疼痛评估的初步搜索中产生的 267 个摘要中,有 24 篇符合纳入和排除标准的 4 级证据文章。没有研究检查急性护理环境中的疼痛评估。虽然 18 篇文章研究了评估疼痛强度的工具,但其余 6 篇文章则专注于 SCI 人群中的疼痛分类。总之,ASIA 标准是一种合适的工具,可以随着时间的推移,对脊髓损伤成年人的运动和感觉功能进行分类和评估。然而,由于缺乏针对反应性的一些关键要素的研究,包括最小临床重要差异,建议进一步研究 ASIA 标准的心理测量特性。视觉模拟评分(VAS)是评估 SCI 人群疼痛强度最常用的评估工具。然而,需要进一步研究其在 SCI 人群中的可靠性和反应性。我们的结果还表明,对于这一特定人群,没有具有适当心理测量特性的工具。